Outcomes of Percutaneous Coronary Intervention in Heavily Calcified Left Anterior Descending Artery using Rotational Atherectomy

Authors

  • Waseem Ashraf Ch. Pervaiz Elahi Institute of Cardiology, Wazirabad-Pakistan.
  • Waqas Jamil Ch. Pervaiz Elahi Institute of Cardiology, Wazirabad-Pakistan.

Keywords:

Percutaneous Coronary Intervention, Heavily Calcified, Left Anterior Descending Artery, Rotational Atherectomy, Intravascular Ultrasound.

Abstract

Introduction: Left anterior descending artery (LAD) stenosis presents grave risks including myocardial infarction, heart failure, and mortality. While coronary artery bypass grafting is a preferred option, some cases require percutaneous coronary intervention (PCI) due to contraindications for surgery. In situations where heavily calcified LAD vessels complicate revascularization, rotational atherectomy (RA) emerges as an advanced technique. This case study explores the successful application of PCI with RA in managing LAD-related reversible ischemia, highlighting patient selection and intravascular ultrasound (IVUS) guidance.

Case Presentation: A female patient exhibited reversible LAD ischemia, carrying high risks of adverse cardiac events. Unsuitable for surgical intervention, PCI with RA was considered. Intravascular ultrasound confirmed severe calcification, guiding procedural planning. Under guidance, RA effectively addressed the calcified plaque, followed by stent placement to restore blood flow. IVUS post-stenting confirmed optimal stent expansion and apposition.

Results: Utilizing RA in PCI achieved successful revascularization of the heavily calcified LAD. IVUS played a crucial role, ensuring precise lesion assessment, plaque modification, and stent optimization. Post-PCI, the patient experienced symptom relief and enhanced myocardial perfusion. Follow-up revealed sustained improvements in symptoms and cardiac function, reinforcing the efficacy of this approach.

Conclusion: In cases unsuitable for surgical revascularization, PCI with rotational atherectomy proves valuable for treating heavily calcified LAD lesions. This study emphasizes thorough patient evaluation, precise lesion assessment via IVUS, and careful procedural planning. The successful outcome underscores RA-assisted PCI's potential to improve patient well-being and address LAD stenosis-induced ischemic risks, advocating its integration for challenging LAD cases.

References

Patrick Whitlow, Ravi Nair. Rotational Atherectomy. General description of procedure, equipment, technique. 2019. Available at: https://www.thecardiologyadvisor.com/home/decision-support-in-medicine/cardiology/rotational-atherectomy/

Matsukawa R, Matsuura H, Tokutome M, Okahara A, Hara A, Okabe K, Kawai S, Mukai Y. Use of a Cutting Balloon Reduces the Incidence of Distal Embolism in Acute Coronary Syndrome Requiring Predilatation Before Stenting. Circ Rep. 2022;4(8):345-352.

Ku PM, Huang TY, Chen ZC, Woo M, Hung JS. IVUS-guided rotational atherectomy for unexpandable paclitaxel-eluting stent: A case report and review of literature. JGC. 2013;10(3):226-229.

Kato T, Fujino M, Takagi K, Noguchi T. The rotational atherectomy with a guide extension catheter for calcified and tortuous lesions in left anterior descending artery: a case report. BMC Cardiovascular Disorders. 2021;21:1-4.

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Published

2023-09-04

How to Cite

Ashraf , W., & Jamil, W. (2023). Outcomes of Percutaneous Coronary Intervention in Heavily Calcified Left Anterior Descending Artery using Rotational Atherectomy. Cathalogue, 1(1), 19–24. Retrieved from https://pjcvi.com/index.php/Cathalogue/article/view/60

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Articles